Bulawayo, Zimbabwe – In 2023, Lloyd Muzamba was critically injured in a car accident on the Harare–Bulawayo highway and urgently required a blood transfusion to survive. Though he was admitted to Mpilo Central Hospital, the largest public health facility in Zimbabwe’s Matabeleland region, a shortage of supplies meant there wasn't enough blood available for him.
In a state of distress, Muzamba’s family turned to the only alternative – a nearby private hospital, which sold them the three pints of blood. However, at $250 per pint, Muzamba, who earned a $270 monthly salary and had no savings, was unable to afford the treatment.
With time running out, the family had to come up with a solution. Eventually, Muzamba’s uncle sold a cow for $300 and asked other relatives to contribute the remaining amount.
Two years later, the now-recovered Muzamba says the experience has left him with psychological scars, as he continues to worry about potential future emergencies when others may need lifesaving blood.
"Three pints may seem like a small amount; others might need more. But due to the costs, it becomes life-threatening," said the 35-year-old, who works in a hardware store in Bulawayo.
"I couldn’t get the blood without either paying upfront or arranging a payment plan. It was a painful ordeal for an ordinary Zimbabwean like me."
Muzamba's situation is not unique.
Amid ongoing currency struggles, rising living costs, and widespread poverty, many desperate Zimbabweans in need of medical care face life-threatening delays due to financial obstacles. This includes blood shortages, even though supplies are supposed to be free in public health facilities.
Tanaka Moyo, a mother of two from the capital, Harare, also faced the stress of having to pay for emergency blood supplies during the birth of her second child.
After suffering from severe postpartum hemorrhaging, the 38-year-old street vendor required four pints of blood.
Along with her husband, a security guard, Tanaka Moyo had already struggled to raise money for the birth of their child. The unexpected need for a blood transfusion added an unplanned and shocking expense.
“My husband ran around and borrowed money from a microfinance institution. The interest rates are high, and the conditions are strict, but he had to act fast,” said Moyo.
“At the hospital, they insisted the blood was free – but it was unavailable.”
Plaxedes Charuma, a gynaecologist in Bulawayo, states that “postpartum hemorrhage is the leading cause of maternal mortality.” Given the high prevalence of the condition, health experts argue that hospitals should always have blood supplies ready to address maternal blood loss emergencies.
According to the Community Working Group on Health (CWGH), a network of civic health organizations in Zimbabwe, the country faces a high demand for blood transfusions, particularly affecting pregnant women.
“About half a million pregnancies are expected in Zimbabwe, and some of these experience excessive blood loss, requiring at least three pints of blood for transfusion,” said Itai Rusike, CWGH’s executive director.
“Maternal mortality in Zimbabwe remains unacceptably high,” Rusike told Al Jazeera. “Timely blood transfusions can prevent maternal deaths, which currently stand at 212 women dying per 100,000 live births.”
'Free Blood for All'
There are generally two major types of blood transfusions: autologous and allogeneic. Autologous transfusion refers to an individual donating their own blood for later use, while allogeneic transfusion, the more common type in Zimbabwe, involves administering blood donated by one person to another who matches their blood type.
The National Blood Service Zimbabwe (NBSZ) oversees blood donation and distribution in the country. It operates as an independent not-for-profit entity, legally mandated to collect, process, and distribute blood across Zimbabwe.
Although the Ministry of Health and Child Care is represented on its board of directors, NBSZ operates independently of hospitals and government health institutions. It is not present in every facility but ensures decentralized distribution through five regional centres: Harare, Bulawayo, Gweru, Masvingo, and Mutare.
Historically, patients in Zimbabwe had to pay for blood, but over the years, the government has worked to reduce costs – from $150 per pint in 2016 to $50 by 2018.
In July 2018, the government took a further step, making blood free at all public health institutions.
“The free blood for all initiative is proceeding as planned, with mechanisms already in place to finance it. By July 1, 2018, blood will be available for free,” said then-Minister of Health and Child Care, Dr. David Parirenyatwa, during the June 2018 World Blood Donor Day celebrations.
However, despite the policy, hospitals continue to face shortages.
In May, there was a critical blood shortage in public hospitals, putting thousands of lives at risk, according to the Ministry of Health and Child Care. Al Jazeera reached out to ministry spokesperson Donald Mujiri for comment on the shortage and the implementation of the free blood policy, but did not receive a response.
Meanwhile, the National Blood Service Zimbabwe (NBSZ) stated that the May shortage was due to operational and systemic challenges that disrupted routine blood collection.
“Without timely financial support, we faced difficulties in mobilizing outreach teams, securing fuel, and purchasing essential supplies,” said Vickie Maponga, NBSZ communications officer.
“Additionally, the situation was worsened by a seasonal dip in donations, particularly from youth, who make up over 70% of our donor base.”
These shortages often force patients to purchase blood from private clinics. In many cases, patients are physically transferred to private facilities for transfusions, where they cover the costs. In some instances, the patient pays, and the private hospital sends the blood to the public hospital.
Crucial Blood Donations
The World Health Organization (WHO) aims to ensure that all countries practicing blood transfusions obtain their blood supplies from voluntary blood donors.
The National Blood Service Zimbabwe (NBSZ) told Al Jazeera that a sustainable blood supply in Zimbabwe relies on cultivating a culture of regular, voluntary donations, particularly among the youth and underserved communities.
The service uses a mobile outreach model to bring blood donation drives directly to schools and communities. To further engage young people, Maponga explained that they started a club that "encourages young people to commit to donating blood at least 25 times in their lifetime."
“We also integrate blood donation awareness into school programs and partner with tertiary institutions to ensure continuity after high school,” she added.
Ivy Khumalo, 32, has been donating blood since high school. However, she says the lack of nearby donation centers as an adult limits her ability to continue donating.
“As a school child, it started as a result of peer pressure, but I found it fascinating,” Khumalo said. “It was only when I became an adult that I made a personal decision to continue donating out of love to save lives and help those in need.”
Since moving from Bulawayo to Hwange, Ivy Khumalo says donating blood has become costly, as the nearest donation center is in Victoria Falls, more than 100km (62 miles) away.
The National Blood Service Zimbabwe (NBSZ) states it regularly deploys mobile blood drives across the country and offers incentives to donors.
“Regular donors who meet specific criteria, such as making at least 10 donations with the most recent within the past 12 months, qualify for free blood and blood products for themselves and their immediate family members during medical emergencies,” explained Maponga.
However, for dedicated donors like Khumalo, the challenge of traveling to a distant donation site becomes a barrier.
“In such circumstances, it’s no longer a free donation as I have to spend money to get there. In the end, most of us decide to stay home despite our passion for donating,” she said.
Itai Rusike of the Community Working Group on Health (CWGH) argues that the NBSZ and the Ministry of Health and Child Care must urgently find innovative and sustainable ways to increase the number of eligible blood donors.
“The government should use the Health Levy Fund, the 5 percent tax on airtime and mobile data, which was set up specifically to subsidize the cost of blood and help public health institutions replace outdated equipment and address drug shortages,” he said. “That money should be ring-fenced and used for its intended purpose in a more accountable and transparent manner.”
Promises and Shortages
Authorities state that by mid-2025, Zimbabwe’s national blood supply is showing positive progress, with the National Blood Service Zimbabwe (NBSZ) having already collected over 73% of its half-year target (with the 2025 annual target set at 97,500 units).
The NBSZ also emphasizes the Ministry of Health and Child Care’s crucial role in subsidizing and overseeing the cost of blood within the public health sector.
“Since 2018, the free blood policy has been made possible through a government-funded coupon system, which covers the full cost of $250 per unit, resulting in zero cost for recipients in public hospitals,” explained Maponga.
The NBSZ maintains that it operates on a cost-recovery basis, with the full process of collecting, processing, and distributing a pint of blood costing $245. The agency charges $250, earning a $5 profit per pint.
However, at some private facilities, the price can reach up to $500 per pint, which has sparked a heated debate on social media, as the high cost is out of reach for many Zimbabweans.
“NBSZ does not regulate how private institutions price their services to patients,” Maponga explained. While the blood itself is donated freely, the complex process from “vein to vein” involves significant resources.
Observers argue that more could be done to lower the cost of blood transfusions.
“Upon closer inspection, the entire blood transfusion process could cost less than $150 by strategically deploying available resources, utilizing corporate donors, and holding the government accountable to fund the entire process,” said Carlton Ntini, a socioeconomic justice activist in Bulawayo.
While the free blood policy in public hospitals is well-intentioned, Ntini says without full implementation, it remains a false hope that only benefits the “lucky” few, as shortages persist.
“In reality, any cost above $50 per pint of blood will still be too high for Zimbabweans, and it becomes a death sentence,” he concluded.
For patients, the cost of essentials only compounds an already stressful situation.
Muzamba was fortunate that his family did not demand repayment for the money they provided for his blood transfusion. However, Moyo and her husband struggled to pay off their $1,000 loan, which increased to $1,400 due to interest.
“It psychologically drained me more than the physical pain, as I kept wondering, ‘Where will I get such money in this economy?’” said Moyo. “The government must fulfill its promises – it’s not just about making blood free, but ensuring it is accessible.”